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The Acne Period

New study offers first real evidence that acne flares during the menstrual cycle

THURSDAY, Dec. 20, 2001 (HealthDayNews) -- Modern science has finally caught up with what women have been saying for ages: Acne rises and falls with the menstrual cycle.

A new study found that the skin breakouts can follow the same or a similar 28-day cycle as the menstrual period, flaring just before bleeding starts, and calming down soon after bleeding begins.

"It's one of those facts of medicine that everybody kind of took for granted as being true, but no one really bothered to see if it held up to scientific scrutiny," says Dr. Ted Daly, director of pediatric dermatology at Nassau University Medical Center in New York. The fact that it did is what gives this research impact, says Daly, who was not affiliated with the study.

Acne is an inflammatory condition of the oil-producing glands and the hair follicles. If anything blocks or hampers the flow of oil from the tiny pores leading from those glands to the skin's surface, it can lead to acne. Likewise, anything that increases oil production can also encourage pimple formation -- including hormonal activity -- and therein may lie the link to the menstrual cycle.

"The hormones may modulate sebaceous activity of inflammation," says Dr. Guy Webster, study co-author and professor of dermatology at Thomas Jefferson Medical College in Philadelphia.

He does warn, however, that hormones alone are not the sole reason for acne, and women should not be quick to blame their breakouts only on their menstrual cycle.

"Acne is the combination of bacterial growth, inflammation, plugging and hormones," says Webster.

One little-known factor that can sometimes figure into the equation is the size of a woman's pores. Indeed, the smaller the pores, the greater the chance of clogging, which is the first step of pimple formation. Perhaps not coincidentally, the researchers note that pores also shrink and expand in direct relation to the menstrual cycle -- with pores smallest on days 15 to 20.

As Daly points out, this just happens to be the same time when hormone activity is the highest -- just following ovulation around mid-cycle. Since pimples take about a week to form, he says, the hormone peak is likely to make the breakout period be just prior to the start of bleeding.

Webster agrees. "The timing of hormone change with acne flares may not be instantaneous; there could be a several day [or] week lag in disease response," he says.

The study itself looked at the premenstrual skin conditions of 400 women from 12 to 52 years old. Each answered survey questions designed to reveal any cyclical patterns to her acne flare-ups, specifically, whether or not the breakouts grew worse before, during or after the onset of each monthly period.

The answers were categorized according the women's age, the severity of their acne, their ethnic background, and whether they used birth control pills.

Of the 400 women, almost half -- 177 participants -- reported that they had premenstrual acne. Of all the factors involved in the survey, only age seemed to make a real difference in the findings.

Indeed, study results showed that 53 percent of women over age 33 had among the highest rates of premenstrual acne, higher than women under age 20, who reported only a 39 percent increase in acne right before the onset of their period.

Surprisingly, birth control pill use made no difference, something that Daly finds interesting.

"If hormonal fluctuations are thought to be behind the breakout, then women who take birth control pills, with a steady level of hormones and no ovulation, would have a decrease in premenstrual acne, and they didn't. So that has to tell you that something else related to the menstrual cycle is affecting the skin," he says.

That "something," he theorizes, could be water retention.

Although not discussed in this study, in the past at least some dermatologists believed that the swelling of the skin resulting from premenstrual water retention can also cause a narrowing of the pores, contributing to clogging and ultimately causing a flare up of premenstrual acne.

For some women, says Daly, the solution can be as simple as a diuretic -- a medication that helps pull excess water from the tissues.

Webster, however, doesn't buy that theory. There is "no reason to think that water retention plays a role in acne," he says. And, he adds, their study didn't address the issue.

The new research appears in the December issue of the Journal of The American Academy of Dermatology.

What To Do

If you suffer from premenstrual breakouts, doctors say it should be treated like any other acne, and you should seek dermatological care if the problem is severe.

"Therapy appropriate to the severity of disease should be prescribed," says Webster.

This can sometimes include the use of antibiotics, or a variety of topical preparations. Although the study didn't appear to show that birth control pill use made a difference, many dermatologists do believe that birth control pills can help some women with acne, and you don't have to stick only to those advertised as being good for your skin.

"Probably all birth control pills help acne, not just the ones whose maker did studies to prove it," says Webster.

To learn more about how acne occurs, visit Acne Net.

To learn the anatomy of a pimple, including how it develops, click here.

To discover a full range of treatment options for acne, click here or here for treatment tips.

SOURCES: Interviews with Guy Webster, M.D., study co-author, professor of dermatology at Jefferson Medical College, Philadelphia, Pennsylvania; Ted Daly, M.D., director, pediatric dermatology, Nassau University Medical Center, East Meadow, N.Y.; December 2001 Journal of the American Academy of Dermatology
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